Henry Ford: Ventilator directive prepared for 'worst case scenario,' is not policy

Beth LeBlanc
The Detroit News

Henry Ford Health System has prepared a policy for how its hospitals will determine which patients get to use ventilators should need surpass availability. 

A letter circulated online Thursday said patients “will be assessed for eligibility” for ventilator support based on the extent of their symptoms, underlying health conditions and advanced directives.

That letter was in preparation for a "worst case scenario," but has not been enacted as policy, the Detroit-based five-hospital system said in a statement. 

The hospital system has not reached capacity at any of its locations, nor has it reached the limit on ventilators at any of its hospitals, said Brenda Craig, vice president of the health system’s integrated communications.

“The letter is part of a larger internal document that unfortunately was shared publicly,” Craig said. “It would only be something used in a worst case scenario, and we are not in one right now at any of our hospitals.”

The policy would only be activated if a hospital reached capacity both within its own system and among the hospitals statewide to which it could send patients, said Dr. Adnan Munkarah, chief clinical officer for Henry Ford Health System,

The over-arching goal of such polices, he said, is to provide the "highest rate of survival" possible and the policies are always "governed by objective medical evidence." The hospital system has an adequate supply of ventilators, he said, and is looking at different options, such as using anesthesia equipment to supplement the hospital's supply. 

“We have by no means exhausted all of our resources or all of our options to take care of patients,” Munkarah said.

The policy is similar to what other hospitals across the nation have prepared, both for this crisis and past challenges, such as the potential spread of the Ebola epidemic between 2013 and 2016, said Karen Smith, director of ethics for Henry Ford Health System.

"In developing our triage plans, our hope is to never have to utilize them,” Smith said. 

The letter circulated online indicates that a patient or patient’s family should alert staff of any medical conditions or advanced directives such as a Do Not Resuscitate order.

Conditions such as terminal cancers, severe trauma or heart, lung or liver failure could make someone ineligible for a ventilator in the intensive care unit, the letter said. Ineligible patients “will receive treatment for pain control and comfort measures.”

“Some patients will be extremely sick and very unlikely to survive their illness even with critical treatment,” the letter said. “Treating these patients would take away resources for patients who might survive.”

Patients who do not improve over time with ventilator or ICU treatment could have the treatment stopped, the letter said.

In the midst of the coronavirus pandemic, hospitals must be prepared for a "worst case scenario," said Munkarah said Friday morning.

"Gathering the collective wisdom from across our industry, we carefully crafted our policy to provide critical guidance to healthcare workers for making difficult patient care decisions during an unprecedented emergency," he said.

"These guidelines are deeply patient focused, intended to be honoring to patients and families. We were pleased to share our policy with our colleagues across Michigan to help others develop similar, compassionate approaches. It is our hope we never have to apply them and we will always do everything we can to care for our patients, utilizing every resource we have to make that happen.”

The letter was circulated widely on Twitter Thursday night before Henry Ford Health System responded shortly after midnight to various tweets referring to the policy, including one from University of Michigan law professor Nicholas Bagley.

“With a pandemic, we must be prepared for worst case,” the health system said in the tweet. “With collective wisdom from our industry, we crafted a policy to provide guidance for making difficult patient care decisions. We hope never to have to apply them. We will always utilize every resource to care for our patients.

Bagley, who has since removed the document from Twitter, occupies “a temporary position as special counsel in the Michigan governor’s office to aid in the state’s response to the coronavirus pandemic” as of March 21, according to an automatic response from his UM email.